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The DSM-IV and the DSM-V have been criticized for creating too many diagnostic categories between psychopathology and normal psychological phenomena. Both emphasize on the difficulties of drawing a precise distinction between normality and psychopathology. The DSM-IV defines mental disorders as A) a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual. B) is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. C) must not be merely an expectable and culturally sanctioned response to a particular event.
D) a manifestation of behavioral, psychological, or biological dysfunction in the individual. E) neither deviant behavior nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual. The DSM-V definition of mental/psychiatric disorder is A) a behavioral or psychological syndrome or pattern that occurs in an individual. B) the consequences of which are clinically significant distress or disability.
C) must not be merely an expectable response to common stressors and losses or a culturally sanctioned response to a particular event. D) that reflects an underlying psychobiological dysfunction. E) that is not solely a result of social deviance or conflicts with society. F) that has diagnostic validity using one or more sets of diagnostic validators. G) that has clinical utility. Both provided distinct details of mental disorder, however, it is still unclear as to what kinds of disorder is classified a mental disease and what are their differences.
This paper will go in depth of what a mental disorder is in association with specific disorders such as anxiety, obsessive-compulsiveness and other related disorders.
Obsession is the persistent thought, urge, or image that is experienced repeatedly, feels intrusive, and causes anxiety. Compulsive is repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety. One survey conducted wanted to identify areas with the help of expert consensus/disagreement to help steer research efforts toward DSM-V classification of obsessive-compulsive disorder (OCD). So, they conducted a worldwide survey among OCD experts. The e-mail addresses of 303 corresponding authors of papers on OCD published between 1996 and 2006 was used. The survey asks questions regarding the classification of OCD and how to improve it on email to the experts. Regarding whether OCD should be removed from the current category of anxiety disorders, approximately 60 percent agreed, and 40 percent disagreed. The survey also revealed that if a new OCD spectrum disorders category is created, the expert consensus is to keep it narrow and only include body dysmorphic disorder (72% agree), trichotillomania (70% agree), and possibly tic disorders (61% agree) and hypochondriasis (57% agree).
Another cognitive assessment of obsessive-compulsive disorder wanted to emphasize the importance of cognitive contents, specific beliefs and appraisals and cognitive processes in the etiology and maintenance of OCD. They decided to develop measures of the relevant cognitive contents and processes by using several scales that have been developed, although many are unpublished and a great deal of them overlap among measures. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. In summary, consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) over the importance of thoughts; (3) excessive concern about the importance of controlling one’s thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism. Moving on, obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders are common in Western society. They usually first appear in childhood or adolescence and more women are diagnosed often than men by a ratio of 2:1. To be classified as someone who has obsessive-compulsive disorder you must have an occurrence of repeated obsessions, compulsions, or both, the obsessions or compulsions take up considerable amount of your time and significant distress or impairment must be present. It was mention that for most people, they find it comforting to follow set routines when they carry out everyday activities. Forty percent become irritated if they must depart from their routines.
Freud mentioned that OCD is played out in overt thoughts and actions. Specifically, he mentioned that “Id impulses” equals to obsessive thoughts and “Ego defenses” equals to counter-thoughts or compulsive actions. Also, OCD is related to the anal stage of development where people who suffer from it usually have a period of intense conflict between the “id” and the “ego.” However, not all psychodynamic theorists agree. Psychodynamic therapies seek to uncover and overcome underlying conflicts and defenses using free association and interpretation. Behaviorists like to concentrate on explaining and treating compulsions rather than obsessions. Exposure and Response Prevention is a type of treatment behaviorist use where it exposes a client to anxiety-arousing thoughts or situations and then prevents the client from performing his or her compulsive acts. Cognitive theorists indicate that everyone has repetitive, unwanted, and intrusive thoughts and suggest that people with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result. People with OCD tend to have exceptionally high standards of conduct and morality and believe thoughts are equal to actions and are capable of bringing harm as well as they believe people have perfect control over their thoughts and behaviors. Additionally, therapy may include, psychoeducation and guiding the client to identify, challenge, and change distorted cognitions. Research suggests that a combination of the cognitive and behavioral models is often more effective than intervention alone.
The biological perspective of OCD is abnormal serotonin activity and abnormal brain structure/functioning. OCD is linked to brain structures such as the orbitofrontal cortex, caudate nuclei, thalamus, amygdala, and cingulate cortex. They believe that some of these structures may be too active in people with OCD and some research provides evidence that these two lines may be connected. Serotonin along with other neurotransmitters (glutamate, GABA, and dopamine), plays a key role in the operation of the orbitofrontal cortex and the caudate nuclei. Abnormal neurotransmitter activity could be contributing to the improper functioning of the circuit. Some biological therapies suggest the use of some serotonin-based antidepressants can help rebalance the brain circuitry. On average these antidepressants bring improvement to 50–80 percent of those with OCD. However, a relapse can occur if medication is suddenly stopped. The most effective research suggests that combination therapy (medication and cognitive behavioral therapy approaches) may be most helpful.
In the article titled, Understanding and treating the obsessive and compulsive disorder, by Paul M. Salkovskis, believes that developments in cognitive theory suggest that the key to understanding obsessional problems lies in the way in which intrusive thoughts, images, impulses, and doubts are interpreted. Having negative interpretations usually concerns the idea that the person’s action or choice not to act can result in harm to oneself or others. This can lead to several severe consequences such as motivating neutralizing behavior and other counter-productive strategies, increasing selective attention, and increased negative moods. Which can lead to maintaining the negative beliefs and therefore the obsessive and compulsive problem will arise.
Moreover, what distinguishes fear from anxiety? Fear defined as the body’s response to a serious threat to one’s well-being and anxiety is the body’s response to a vague sense of being in danger. They both have the same physiological features and prepare us for action by increases respiration, perspiration, muscle tension, etc. For some people, the discomfort is too severe or too frequent, lasts too long, or is triggered too easily. According to the DSM-V, 18 percent of the adults in the U.S. population experiences one of the anxiety disorders, close to 29 percent develop one of the disorders at some point in their lives and only one-fifth of these individuals seek treatment. The DSM-V Anxiety Disorders includes generalized anxiety disorder (GAD), specific phobias, agoraphobia, social anxiety disorder, and panic disorder. General anxiety disorder (GAD) is characterized as; 1) for 6 months or more, person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters, 2) the symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems, and 3) significant distress or impairment. GAD is most likely to develop in people who face ongoing, dangerous societal conditions, who live in poverty, or who face discrimination, low income, and reduced job opportunities. According to the 2015 Children Mind Institute, Children’s Mental Health Report, anxiety and depression are treatable, but 80 percent of kids with a diagnosable anxiety disorder and 60 percent of kids with diagnosable depression are not getting treatment. Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement, an estimated 31.9% of adolescents had any anxiety disorder. Of adolescents with any anxiety disorder, an estimated 8.3% had severe impairment. The prevalence of any anxiety disorder among adolescents was higher for females (38.0%) than for males (26.1%). The Psychodynamics Perspective explains when childhood anxiety goes untreated, anxiety will progress to a more difficult stage. Some psychodynamic therapies include general techniques such as treating all psychological problems by free association, transference, resistance, and dreams. Object relations therapies help patients identify and settle early relationship problems. Child Psychologist, Sigmund Freud, focus less on fear and more on control of the “id”.
Researchers have found some support for the psychodynamic perspective. They found that people with GAD are particularly likely to use defense mechanisms (especially repression). Adults, who as children suffered extreme punishment for expressing “id impulses”, have higher levels of anxiety later in life. According to the humanistic perspective, GAD arises when people stop looking at themselves honestly and acceptingly. The humanistic therapy developed by Carl Rogers in which clinicians try to help clients by being accepting, empathizing accurately, and conveying genuineness is best to treat GAD. According to the cognitive perspective, research supports that people with GAD hold maladaptive assumptions, particularly about dangerousness. When these assumptions are applied to everyday life and to more events, GAD may develop.
Next, another disorder that many do not consider a disorder is worrying. In one survey, 62 percent of college students said they spend less than 10 minutes at a time worrying and 20 percent worry for more than an hour. According to the cognitive perspective, in order to treat individuals with GAD is to help them to recognize their inclination to worry. Helping clients to become aware of streams of thoughts and to accept these as mind events is called “mindfulness-based acceptance therapy.” Alternatively, some of today’s modern new cognitive therapists specifically guide clients with a generalized anxiety disorder to recognize and change their dysfunctional use of worrying. Clients educated about the role of worrying in GAD are taught to observe their bodily arousal and cognitive responses across life situations and become increasingly skilled at identifying their reactions.
According to the biological perspective, the circuit in the brain that helps produce anxiety reactions includes areas such as the amygdala, prefrontal cortex, and anterior cingulate cortex.
Biological theorists believe that GAD is caused primarily by biological factors. During the 1950s, Benzodiazepines such as what we know today as Valium and Xanax found to reduce anxiety. Neurons in our brain have specific receptors and benzodiazepine receptors ordinarily receive gamma-aminobutyric acid (GABA, a common neurotransmitter in the brain) which carries inhibitory messages and when received, it causes a neuron to stop firing. When a feedback system is triggered the brain and body activities work to reduce excitability. Some neurons release GABA to inhibit neuron firing, thereby reducing the experience of fear or anxiety. Malfunctions in the feedback system are believed to cause GAD because of too few receptors or ineffective receptors.
In conclusion, a mental disorder is a wide range of conditions that affect mood, thinking, and behavior. Other disorders include clinical depression, bipolar, dementia, attention-deficit/hyperactivity disorder, schizophrenia, autism, post-traumatic stress disorder and etc. Many people in the world may have mental health concerns from time to time but a mental health concern can become a mental health illness when you experience ongoing signs and symptoms or frequently feeling stress to the point where it can affect your ability to properly function on a daily basis. Signs and symptoms can vary depending on the type of disorder and other factors as well. Mental illness can affect your thoughts, behavior, and emotions. Treatment should be considered either by talking to someone such as your doctor, therapist, and even love ones to prevent the illness to worsen over time.
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